June 21, 2019 by John Fernandez
New Screening Guidelines for Abdominal Aortic Aneurysms
Actor George C. Scott, French General Charles de Gaulle and physicist Albert Einstein – each renowned in his respective field – all taken down by a silent killer known by vascular specialists and cardiologists as abdominal aortic aneurysm, or “Triple A.”
Now for the first time since January 2005, the U.S. Preventive Services Task Force has updated its screening guidelines to allow wider use of AAA screenings in older men who have never smoked.
“Until now, Triple A screenings were reserved for men, 65 to 75 years old, who are currently or had been smokers,” explained Barry Katzen, M.D., an interventional radiologist who treats abdominal aortic aneurysms and the founder and chief medical executive of Miami Cardiac & Vascular Institute. “Now, men, regardless of their smoking history, may be screened, if they have other risk factors.”
Abdominal aortic aneurysms occur when the wall of the aorta – the large artery that carries blood from the heart to the rest of the body – weakens and can no longer hold the volume of blood passing through it, Dr. Katzen says. That weakened spot bulges from the blood inside and can eventually rupture without warning.
“It’s much like a blister on a tire,” Dr. Katzen said. “When that blister pops, you have a blow out. Similarly, when an aneurysm ruptures, we’re on the clock to save that person’s life.”
According to Dr. Katzen, the new screening guidelines for AAA take into account family history, which he says is the strongest risk factor in developing this type of aneurysm, ahead of smoking history.
“Now, if we know about a family history of Triple A, we’re likely to examine the patient for an aneurysm – first through a physical exam of the abdomen, then using ultrasound to gauge the size and location of it,” he said.
He also notes that many aneurysms are found coincidently, such as when a patient has a CT scan for back pain or an ultrasound of the abdomen, because they typically don’t cause symptoms until they rupture. With the updated guidelines, Dr. Katzen hopes to find more aneurysms that are manageable – either through frequent monitoring or through surgical or endovascular repair (f the blood vessel using a stent – a procedure pioneered by doctors at the Institute.
As for why women weren’t included in either the old or new guidelines, Dr. Katzen says that abdominal aneurysms are very rare in women – 1 case to every 8 in men.
“We don’t know the exact reason men are more inclined to have these aneurysms, but we believe there may be a genetic link,” he said.
Once an aneurysm is discovered, Dr. Katzen says the goal is to prevent a life-threatening rupture. Longtime senator and former presidential candidate Bob Dole had his aortic aneurysm repaired in 2001.
“These new guidelines will allow us to tell more success stories about people who have been given a chance to live, despite their abdominal aortic aneurysm,” Dr. Katzen said.